MENCAP - East Cornwall Support Service is a supported living service that provides personal care to people living in their own homes. Supported living services aim to enable people to live as independently as possible in the community. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support.

The service supports people living in 11 separate houses throughout the east of Cornwall. Some of these houses had previously been registered as care homes. At the time of our inspection the service supported 57 people with learning disabilities, 34 of whom received personal care.

We carried out this announced inspection on 12 and 17 October 2018. At the previous comprehensive inspection in August 2016, the service was rated Good. An additional focused inspection was completed in October 2017 in response to concerns about staffing levels at a particular house. The focused inspection also found that the service was good as the provider had taken appropriate measures to ensure people’s needs were met. Prior to this inspection we again received information of concern in relation to staffing levels at the same house.

At this inspection we found that the service did not currently employ enough staff to provide all planned care and that agency staff were used regularly throughout the service. People told us low staffing levels had impacted on their ability to access the community and records showed people had been unable to participate in activities they enjoyed due to staffing issues. Staff told us, “Staffing levels have been testing. There were only five permanent staff when I started. A lot of agency”, “Agency staff are normally on five out of seven days” and “We are understaffed quite often…It has been pretty short at times.” Staffing records showed and managers accepted that there had been times during the summer when planned staffing levels had not been achieved.

Issues with the quality and accuracy of people’s care plans and associated records were identified throughout the service. People’s care plans did not always accurately reflect the support staff provided. Staff told us, “I know the care plans are not accurate. The information is out of date” and “The paperwork is a mess, it got to the point in July and August where I was having to copy paper work at home to use.” Summary records of incidents had not been completed accurately or logically and did not include details of all incidents that had occurred.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service did not have a registered manager at the time of our inspection and there had been a number of leadership changes within the service since our last inspection. However, an area manager had been recently appointed and an application for their registration was submitted following our inspection.

Each house where the service provides support was led by a service manager who reported to the area manager. We found there had been a number of changes of service managers since our last inspection. In the house in which concerns had been raised about staffing levels there had been a lack of consistent leadership. Staff did not feel adequately supported and told us, “Continuity is key and this has not been there. I think there has been a horrible perfect storm to destabilise the [house] with the lack of continuity.”

The providers quality assurance system had identified these issues prior to our inspection and significant additional leadership support had been provided to the staff team. Staff reported this support had been a positive impact and tol

This focused inspection was completed to investigate concerns reported to the commission in relation to staffing levels in one of the houses where this service provides supported living care.

We found that although the service was safely staffed overall, there was a particular staff shortage in the house about which concerns had been reported. At the time of our inspection there were three staff vacancies at this house. We reviewed staff rotas and staff signing in sheets in detail and found that all planned care shifts had been provided. However, records showed that 22% of care shifts had been covered by MENCAP bank staff and 15% by agency staff. The service manager responsible for the house said, “We always make sure there is adequate staff there. No one lone works there during the day.” The registered manager recognised that it could be unsettling for people to be supported by staff who they did not know well and had worked with agency staff providers to ensure that the agency staff had previous experiences of working in the house. Records showed that during recent weeks the same members of agency staff had been used regularly. One full time staff member who had worked at the service for over a year commented, “We have agency staff who have worked here longer than I have.”

Prior to the inspection, managers had begun to address these staffing issues. An action plan had been developed and a targeted recruitment campaign had been launched. Staff told us this had resulted in the appointment of two new staff and that further interviews were planned. This demonstrated that the registered manager was responding appropriately to address and resolve the service’s current staffing issues.

We looked specifically at staffing levels at the time of an incident where a person had been exposed to significant risk. We found that staffing levels had not contributed to this incident. Records showed at the time of the incident the house had been over staffed as two managers were visiting the service to review records. Following the incident, appropriate action was taken to prevent similar events from reoccurring.

This meant that although the service has some staffing issues these had not impacted on the quality of care people received.

There were systems and procedures in place to ensure people received their medication when required. Medicines administration records (MARs) had been completed and were regularly audited. Where medicines errors occurred these were investigated and staff were provided with additional training and support. A recent incident had occurred which highlighted that the service had not made appropriate arrangements for a new medicine to be available to a person at their day centre placement. This incident was being investigated and new procedures were being introduced. These were designed to ensure that in future everyone involved in a person’s care was advised of any significant changes to their individual needs.

All staff had been recruited safely and understood their role in protecting people from abuse and avoidable harm. Risk assessments had been completed and staff had been provided with guidance on how to support people to be as independent as possible.

Relatives were confident that the service met people’s needs and told us, “I think they do the best they can for [Person name]” and “[My relative] is very happy there”. Comments from staff included, “I think people are quite happy. People get to do whatever they want to.”

Staff told us they were well supported by their managers who they described as, “brilliant”. Records showed team meetings were held regularly to ensure staff were aware of any planned changes within the organisation and staff told us, “We had one [a staff meeting] just the other day.” A number of changes had made in the service’s management structure. New managers allocated to individual addresses had been provided with informative handovers from their predecessors. One staff m

We carried out this announced inspection on 8 August 2016. We announced this inspection two days before in accordance with the Care Quality Commission current procedures for inspecting domiciliary care service. The service has not been inspected at this location prior to this date.

Mencap – East Cornwall Support Service is a domiciliary service that provides care and support to people with a learning disability or a mental health condition in their own homes. It is part of the Royal Mencap Society. The service provides 24 hour supported living services to 14 people. A supported living service is one where people live in their own home and receive care and support to enable them to live independently without reliance on others. People have tenancy agreements with a landlord and receive their care and support from a domiciliary care agency. These services were funded either through Cornwall Council, direct payments or NHS funding.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People using the service had limited verbal communication and were not able to tell us their views about the care and support they received. However, we observed people were relaxed and comfortable with staff, and they received care and support in a way that kept them safe. People had a good relationship with staff and were comfortable with the staff that supported them.

Families, health and social care professionals told us they felt the service was safe. Comments included, “The service is really good” and “They (staff) provide safe care.”

Staff had received training in how to recognise and report abuse. All staff were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected. There were sufficient numbers of suitably qualified staff to meet the complex needs of people who used the service. The service was flexible and responded to people’s changing needs.

People received care from staff who knew them well, and had the knowledge and skills to meet their needs. Relatives, health and social care professionals spoke well of staff. Comments included, “The staff are absolutely stunning” and “The staff have adapted to meet the continually changing health needs of the people they support very well.”

Staff were knowledgeable about the people they cared for and knew how to recognise if people’s needs changed. Staff were aware of people’s preferences and interests, as well as their health and support needs, which enabled them to provide a personalised service. Staff were kind and compassionate and treated people with dignity and respect.

Managers and staff had a clear understanding of the Mental Capacity Act 2005 (MCA) and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. Support plans contained evidence to show people, or their relatives if appropriate, had consented to the planning and delivery of care.

Support plans were individualised and described people's needs across all areas of their lives. They were reviewed and updated regularly and accurately reflected people's current needs. There was evidence to show external health and social care professionals had been involved in care and support planning when appropriate.

Staff supported people to maintain a healthy lifestyle where this was part of their support plan. People were supported by staff with their food shopping and with the preparation and cooking of their meals.

People were supported to access the local community and they took part in activities that they enjoyed and wanted to do. Records showed t